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Position Summary :

Analyst, Case Management (ACM) drive and support care management and care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating). The ACM utilizes critical thinking and judgment to collaborate and inform the care management/care coordination process in order to facilitate appropriate healthcare outcomes for assigned members. They provide care coordination, support and education for members through the use of care management tools and resources.

Position Responsibilities:

• Uses care management tools and information to complete a comprehensive evaluation of members and recommends an approach to case resolution by determining member needs in alignment with their benefit plan and available internal and external programs and services.

• Identifies high risk factors and service needs that may impact member outcomes and care planning with appropriate referral to clinical case management or crisis intervention as appropriate.

• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve an optimum level of health.

• Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.

• Helps member actively and knowledgably participate with their provider in healthcare decision-making.

• Serves as a single point of contact for members and assists members to remediate immediate and acute gaps in care and access.

• Coordinates and implements assigned care plan activities and monitors care plan progress.

• Using a holistic approach consults with clinical care managers, leadership, medical directors and other physical/behavioral health support staff and providers to overcome barriers to meeting member goals and objectives.

• Presents cases at case conferences/rounds to obtain multidisciplinary review in order to achieve optimal outcomes.

• Works collaboratively with the members’ interdisciplinary care team.

• In collaboration with the member and their care team develops and monitors established plans of care to meet the member’s goals.

• Identifies and escalates quality of care issues through established channels.

• Monitors, evaluates and documents care utilizing case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

• Identifies, refers, and links members to providers and social supports as needed (e.g., scheduling appointments, arranging transportation).

• Educates members about available resources and services such as Illinois value-added benefits and assisting the member in accessing those resources and services.

• Facilitates clinical hand offs during transitions of care.

(Reports to: Manager, Clinical Health Services, Care Management) Required Qualifications:

• Must reside within commutable distance of Downers Grove, IL Office or Downtown Chicago, IL Office

• Ability to travel up to 15%

• 2 years of related professional experience includes acting as a care manager, rehabilitation specialist, health specialist, social services coordinator, or licensed behavioral health professional in the State of Illinois

Preferred Qualifications:

• Case management and discharge planning experience

• Managed Care experience preferred

Education:

• Bachelor’s degree in social work, psychology, or a related social services field

Pay Range

The typical pay range for this role is:

$19.52 - $42.91

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 07/16/2024

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.